In Memory / In Honour Donation

Thank you for choosing to make a donation to support our vision of a world without Alzheimer’s disease and other dementias.

Field Is RequiredEnter A Gift Amount:

$150

$100

$50

$25

Other:

Enter amount

Tribute Information

Gift Type:Required

Who is this gift in honour or in memory of?

Title:Required

First Name:

Last Name:

Who is this tribute donation from?

Should we notify someone of your gift?

Required

Card From Name

Mail a Printed Card

Recipient Name:

Send an Electronic Card

Yes, I would like to send an eCard.

Email Subject Line:

Personal Message:

Please note your personal message cannot exceed 255 characters.

Recipient Email Addresses:

Select an eCard:

Send eCard on:Select month of credit cardSelect Expiration Year

MonthDayYear

Yes, send me a copy of the eCard.

Recipient Address (line 1):

Recipient Address (line 2):

Recipient City:

Recipient Province/State:Required

Recipient Postal/ZIP Code:

Recipient Country:Required

Donor Information

The address you enter below must match your credit card's billing address in order to process this donation. The Canada Revenue Agency requires that donation receipts bear the name and address of the actual donor.

Title:Required

First Name:

Middle Name:

Last Name:

Address (line 1):

Address (line 2):

City:

Province / State:Required

Postal / Zip Code:

Country:Required

Email Address:

Send Info on Gift of Will

Please send me information on how to leave a gift in my Will

Send Estate Planner

Please send me a free estate planner and guide

If you donate and have not already registered, you will receive periodic updates and communications from Alzheimer Society.